Psychosocial assessment following self-harm: Results from the Multi-Centre Monitoring of Self-Harm Project

Centre for Suicide Prevention, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
Journal of Affective Disorders (Impact Factor: 3.38). 04/2008; 106(3):285-93. DOI: 10.1016/j.jad.2007.07.010
Source: PubMed


Psychosocial assessment is central to the management of self-harm, but not all individuals receive an assessment following presentation to hospital. Research exploring the factors associated with assessment and non-assessment is sparse. It is unclear how assessment relates to subsequent outcome.
We identified episodes of self-harm presenting to six hospitals in the UK cities of Oxford, Leeds, and Manchester over an 18-month period (1st March 2000 to 31st August 2001). We used established monitoring systems to investigate: the proportion of episodes resulting in a specialist assessment in each hospital; the factors associated with assessment and non-assessment; the relationship between assessment and repetition of self-harm.
A total of 7344 individuals presented with 10,498 episodes of self-harm during the study period. Overall, 60% of episodes resulted in a specialist psychosocial assessment. Factors associated with an increased likelihood of assessment included age over 55 years, current psychiatric treatment, admission to a medical ward, and ingestion of antidepressants. Factors associated with a decreased likelihood of assessment included unemployment, self-cutting, attending outside normal working hours, and self-discharge. We found no overall association between assessment and self-harm repetition, but there were differences between hospitals--assessments were protective in one hospital but associated with an increased risk of repetition in another.
Some data may have been more likely to be recorded if episodes resulted in a specialist assessment. This was a non-experimental study and so the findings relating specialist assessment to repetition should be interpreted cautiously.
Many people who harm themselves, including potentially vulnerable individuals, do not receive an adequate assessment while at hospital. Staff should be aware of the organizational and clinical factors associated with non-assessment. Identifying the active components of psychosocial assessment may help to inform future interventions for self-harm.

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    • "As the three general hospitals in the City of Manchester are situated in a large conurbation with other emergency hospitals close by, we considered whether repeat episodes were more likely in Manchester than in our other sites to result in attendance at a neighbouring hospital not involved in the study – and thereby not be picked up by our case-finding of repeat episodes. Local audit of attendances at Emergency Departments in nearby hospitals showed, however, that fewer than 5% of Manchester residents who attend hospital attend neighbouring hospitals outside the City of Manchester (Kapur et al., 2008). Further characteristics of the clinical care of patients in Oxford, Manchester and Derby can be found in other published work from the multicentre monitoring project (Bergen et al., 2010, 2012). "
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    ABSTRACT: Self-poisoning and self-injury have widely differing incidences in hospitals and in the community, which has led to confusion about the concept of self-harm. Categorising self-harm simply by a method may be clinically misleading because many hospital-attending patients switch from one method of harm to another on subsequent episodes. The study set out to determine the frequency, pattern, determinants and characteristics of method-switching in self-harm episodes presenting to the general hospital. The pattern of repeated self-harm was established from over 33,000 consecutive self-harm episodes in a multicentre English cohort, categorising self-harm methods as poisoning, cutting, other injury, and combined methods. Over an average of 30 months of follow-up, 23% of people repeated self-harm and one-third of them switched method, often rapidly, and especially where the person was male, younger, or had self-harmed previously. Self-poisoning was far less likely than other methods to lead on to switching. Self-harm episodes that do not lead to hospital attendance are not included in these findings but people who self-harmed and went to hospital but were not admitted from the emergency department to the general hospital, or did not receive designated psychosocial assessment are included. People in the study were a mix of prevalent as well as incident cases. Method of self-harm is fluctuating and unpredictable. Clinicians should avoid false assumptions about people׳s risks or needs based simply on the method of harm. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 04/2015; 180:44-51. DOI:10.1016/j.jad.2015.03.051 · 3.38 Impact Factor
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    • "Further research is required to identify what works for whom, but the current best evidence suggests that providing a psychosocial assessment following self-harm should be seen as a minimum standard for all patients. Those clinicians taking a 'high risk' approach to management (as described by Kapur et al., 2008) should pay particular attention to ethnic subgroups at highest risk of further suicidal behaviour. "
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    Suicidal Behavior of Immigrants and Ethnic Minorities in Europe, Edited by van Bergen D., Montesinos A. H., Schouler-Ocak M., 08/2014: chapter Suicidal Behavior Among Ethnic Minorities in England: pages 45-60; Hogrefe., ISBN: 978-0-88973-453-9
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    • "As with other sensitive issues, collecting prevalence data on NSSI is challenging. As well as problems associated with case definition [12,15,16] official figures based on hospital presentations or hospital clinics routinely underestimate the magnitude of the problem with only a small proportion of people with NSSI reaching a hospital or clinical setting [13,15,16]. Much of the other previous research has been limited to school-aged children with data collected using self-report questionnaires often administered by school teachers or school nurses [12,14,16-20]. "
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